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Maggie Price

Malaka Friedman

English 101

23 October 2018

Rhetorical Analysis of

“The Power of a Liver Transplant Waiting List: A Case Presentation”

Article Summary: The article “The Power of a Liver Transplant Waiting List: A Case

Presentation” tells the story of a woman who was briefly inactive on the liver transplant waiting

list and recounts the emotional journey that her family had to face during this time. It was written

with the purposes of informing potential organ donors about the importance of liver transplants

and persuading health care providers to communicate more clearly with their patients and the

patient’s loved ones. The intended audiences of the article are both possible future organ donors

and medical professionals. The article was published by the American Association of Critical

Care in November of 2014.

The article “The Power of a Liver Transplant Waiting List: A Case Presentation” was

written to inform potential organ donors of the importance of liver transplants and to urge

doctors and nurses to communicate more clearly with their patients and the loved ones of their

patients. The authors, Lissi Hansen, Yi Yan, and Susan J. Rosenkranz, used logos, pathos, and

ethos to achieve this. Despite their use of these methods, the article was still ineffective and did

not fulfill its intended purposes of persuading audience members to become organ donors or

persuading doctors to communicate more clearly with their patients.

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The patient in the case presented is given the pseudonym “Mrs. Johnson”. She suffers

from cirrhosis caused by primary sclerosing cholangitis and was at the top of the liver transplant

waiting list prior to a trip to the ICU to treat massive internal bleeding (Hansen et al). She was

labeled as a “Status 7” patient, meaning that she was temporarily inactivated on the transplant

list. However, being reactivated on the list is easily obtained after certain health issues are

addressed and treated. For the first thirty days that the patient is classified as Status 7, they still

accumulate waiting time for being on the list but cease after the thirty day limit (“Current”). The

medical professionals who were caring for Mrs. Johnson never explained this to her family,

leading her family to believe that she would have to re-enter at the bottom of the list. According

to the article, continued miscommunication between the doctors and the family caused

unnecessary emotional stress for each of the family members (Hansen et al). After Mrs. Johnson

was treated, she was reactivated on the list and received a transplant.

Hansen et al incorporate ethos into their article simply by providing information

regarding their professions and level of education. Hansen and Yan are both registered nurses,

with Hansen having a PhD in nursing. Rosenkranz has a master’s degree in biostatistics. While it

may seem like the authors are very credible due to their education and certifications, there is

evidence that Lissi Hansen, the coordinator of the research project, is biased when it comes to

how a patient’s emotions are affected. Most of her past research is focused on the impact that

hospital visits have on a patient’s family’s emotions (“Lissi”). This shows that she may be partial

to believe that doctors do not explain information well to the patient’s loved ones and that she

may not realize that although doctors are expected to effectively relay information, it is more

important that they treat the patients and help them to heal as quickly as possible. Their first

priority is fixing any problems that the patient has, leaving informing the family to be their
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second concern. Since it is possible that Hansen is biased, it is also possible that when she

interviewed the family, she asked questions in a way that would evoke the type of answer that

she wanted. In this case, that answer would be that they were unsatisfied with the communication

they received from the doctors and nurses. In reality, it may have been that the lack of

communication was very small and did not cause much emotional stress to the family. Overall,

the chance that Hansen is biased detracts from the credibility of the article.

Pathos is used by Hansen et al as quotes taken directly from the patient’s family members

regarding their emotional stress and the lack of communication that they faced from the doctors

and nurses. The authors repeatedly emphasize the impact that the inactive status had on the

patient’s family. Even the title of the article, “The Power of a Liver Transplant Waiting List: A

Case Presentation” was meant to somewhat appeal to the reader’s emotions. From looking at

this, the reader can infer that the main topic is the lack of organ donors and how important it is to

become one. While that is briefly mentioned in the article, the main topic is actually the

miscommunication that sometimes happens between patients’ families and the medical

professionals. Hansen, Yan, and Rosenkranz also use quotes from the family regarding

miscommunication. An example is when one of the family members says, ““What is actually

keeping her off the transplant list? We thought it was only 1 thing, and then it turned out to be 2

or 3 things”” (Hansen et al). In this instance, the family member did not feel as if the doctor

explained the full extent of the patient’s medical complications.

Logos is another technique that the authors used throughout the article. They give

statistics throughout the article, for example, they give the number of people who die per year

waiting for a liver transplant. However, these statistics do very little to back up the message that

Hansen, Yan, and Rosenkranz are trying to convey. They are often placed in less than ideal areas
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of the text or don’t give quite enough information for the reader to be able to make sense of

them. This can be seen when the number of people who die per year waiting for a transplant is

given, “In 2012, 1558 patients listed on the liver transplant waiting list died while waiting and

1501 were too sick to undergo transplant surgery.” (Hansen et al). A total number of people on

the transplant list is not given, so it is impossible for the audience to know if this is a significant

percentage of everyone on the list. A more effective way to present this information would be in

the form of a percent mortality rate for those on the liver transplant list. For example, the percent

mortality rate for people on the liver transplant list who had been diagnosed with primary

sclerosis cholangitis could have been included, which is roughly 7.3% (Freeman).

One main reason why the article is ineffective is because any data presented is presented

at the wrong points within the article and not enough information is given to form an opinion

based on the data. For example, information may be given regarding the survival rates of

individuals who are on the liver transplant waiting list. However, it may be given in a section of

the article that renders it less effective than it would have been in another section. Any

information that is given is very brief, and it almost feels as if the thought that the authors are

trying to convey is not completed before they move on to make another point. The authors focus

on how Mrs. Johnson’s family felt when faced with the news that she was inactivated and how

confused they were regarding the situation, but the article never mentions if the family asked the

medical professionals specific questions that would help clear the air.

The article is not effective in persuading medical professionals to communicate more

clearly with patients because it focuses on one particular case where a set of doctors did not quite

answer all of the questions that family members had regarding the patient’s health. The article

would have been much more effective if it had given data comparing how many people are
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satisfied with the information that their doctors give them to the amount of people that are left

unsatisfied with the information they receive. It also does not include quotes from the family

suggesting that they specifically asked the doctors for clearer answers. One nurse quoted in the

text says “I felt like I was communicating pretty well with him [Mr Johnson], what we were

doing and why we were doing certain things, and explained. … I felt like overall he understood

what was going on.” (Hansen et al). Based on this statement, it seems as if the family is to blame

for any lack of communication.

It is likely that Mrs. Johnson has been hospitalized several times in her life due to the

condition that she suffers from. It is called primary sclerosing cholangitis and causes cirrhosis of

the liver. Patients who suffer from this condition often experience many severe infections that

result in several hospitalizations (“Primary”). In many cases when the patient spends a lot of time

in the hospital, the family begins to understand more medical terms and procedures than do most

ordinary people. It is very likely that the doctors and nurses expected Mrs. Johnson’s family

members to have already heard and understand many of the terms that they mentioned

throughout her stay in the hospital. Doctors and nurses working on the case had no reason to

think that the family was confused because the family never told them that they didn’t

understand. This obvious point that the authors unintentionally made contributes to the

ineffectiveness of the article.

By the end of the article, the reader cannot even be completely aware of what the purpose

of the text was. In the beginning, it seemed as if the authors were trying to convince the reader to

become an organ donor. The article even references the liver shortage, noting that the transplant

list is growing but the number of livers available remains relatively the same (Hansen et al).

Towards the end, it seems as if the audience is no longer those who could be potential organ
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donors, but instead the doctors and nurses who are treating patients on the liver transplant list.

The final paragraph of the article even begins by stating the fact that health care providers “may

be able to reduce families’ emotional turmoil by taking the time to connect with them and to

inquire about how the family sees the situation, acknowledge their feelings, provide

opportunities for them to express feelings, and offer information tailored to their needs.” (Hansen

et al).

While it is common for a piece of writing to have multiple audiences, they usually at least

keep the same purpose throughout the entirety of the text. This article began with the purpose of

persuading people to become organ donors. It ended with the purpose of persuading doctors and

nurses to communicate more often and more clearly with their patients. The article was not

effective in achieving either of its two purposes. It did not successfully persuade people to

become organ donors because it only briefly mentioned that more livers are needed.

Although logos, pathos, and ethos were all used in the article, the purpose was still not

achieved. This is mostly due to the lack of credibility and the misuse or misplacement of data

throughout the article. The article had the potential to be more effective if the authors had used

the methods that they attempted to use correctly. They could have included data that supported

their claims and based their argument more in logos than pathos. Overall, the article was

ineffective due to the misuse of rhetorical factors.

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Work Cited:

“Current Liver Allocation Policies.” Organ Procurement and Transplantation: Assessing

Current Policies and the Potential Impact of the DHHS Final Rule., U.S. National

Library of Medicine, 1 Jan. 1999, www.ncbi.nlm.nih.gov/books/NBK224641/.

Freeman, Richard B., and Erick B. Edwards. “Liver Transplant Waiting Time Does Not

Correlate with Waiting List Mortality: Implications for Liver Allocation Policy.” Liver

Transplantation, Wiley-Blackwell, 30 Dec. 2003,

aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1053/jlts.2000.9744.

Hansen, Lissi, et al. “The Power of The Liver Transplant Waiting List: A Case

Presentation.” American Journal of Critical Care, 1 Nov. 2014, Institute of

Medicine (US) Committee on Organ Procurement and Transplantation Policy.

ajcc.aacnjournals.org/content/23/6/510.full.

“Lissi Hansen, Ph.D., R.N. | OHSU People.” Oregon Health & Science University,

www.ohsu.edu/people/lissi-hansen/AFE02D6ADDF01C12A3D790CAE74E1EAE.

“Primary Sclerosing Cholangitis.” Mayo Clinic, Mayo Foundation for Medical Education and

Research, 8 Mar. 2018, www.mayoclinic.org/diseases-conditions/primary sclerosing

cholangitis/symptoms-causes/syc-20355797.